Provider Demographics
NPI:1013678473
Name:VILLARREAL, NATASHA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 S GOLDEN DR
Mailing Address - Street 2:
Mailing Address - City:SILT
Mailing Address - State:CO
Mailing Address - Zip Code:81652-8613
Mailing Address - Country:US
Mailing Address - Phone:810-623-1304
Mailing Address - Fax:
Practice Address - Street 1:228 S GOLDEN DR
Practice Address - Street 2:
Practice Address - City:SILT
Practice Address - State:CO
Practice Address - Zip Code:81652-8613
Practice Address - Country:US
Practice Address - Phone:810-623-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist